AT meetings of 12-step recovery programs, people offer gripping testimonials about their struggles, and rarely fail to mention how long they’ve been clean. In commercials for Proactiv Solution, the popular acne treatment, celebrities and average joes on the three-step skin-care program tell their tales of woe and often gush about how long their skin has been clear.

The Proactiv sob sell has galvanized even people who rarely have blemishes to become, well, proactive about their skin.

Rebecca Powell, a graduate student in microbiology at New York University, ordered Proactiv three years ago after seeing an infomercial, although she only occasionally gets a pimple.

Ms. Powell said the products dried out her skin, and she stopped using them. But earlier this month, Ms. Powell, 24, purchased a Proactiv sulfur face mask designed to reduce inflamed pimples. “You see the infomercials and you become more aware of body image stuff and it makes you care more, so you buy it,” she said.

Founded in 1995 by two dermatologists, Proactiv has become a phenomenon by transforming the way consumers think about pimples. The brand captured public attention by hiring stars for its infomercials like Vanessa Williams, Jessica Simpson and Sean Combs to lay bare their valiant struggles to attain flawless skin, effectively turning acne into a celebrity malady. But the company’s real innovation was repositioning mild breakouts from a routine annoyance that a dab of Clearasil might fix to a preventable condition, like cavities, requiring vigilant daily upkeep.

“Ten years ago, we covered it up, but their message is ‘you don’t have to have bad skin,’” said Karen Young, the chief executive of the Young Group, a consulting firm to beauty companies. “They have shifted the consumer psyche.”

Proactiv has become a blockbuster by motivating consumers to trade up from a $4.99 drugstore product like Clearasil, made with the antibacterial agent benzoyl peroxide, to a 60-day, three-part regimen, also made with benzoyl peroxide, that costs $39.95 for ongoing subscribers.

The brand now has more than five million active customers and annual worldwide sales of about $850 million, 70 percent of which are in the United States. By contrast, sales of acne products in American drugstores were about $155 million for the year that ended July 15, according to Information Resources Inc., a market research firm.

“Right now, we own acne,” said Greg Renker, a chief executive of Guthy-Renker, the direct-response television company that sells Proactiv. The company spends about $125 million a year buying time for its infomercials on channels like VH1 and MTV as well as Web sites like Facebook, he said. “We are the fastest-growing acne brand in the world.”

The Proactiv story may be just as much about the promotion of acne as a serious disease as it is about the marketing of products to fight it.

“You can get the same amount of benzoyl peroxide at a drug store at a fraction of the cost and it will work as well, provided that you use it,” said Dr. Hilary E. Baldwin, the vice chairwoman of the dermatology department at the State University of New York Downstate Medical Center in Brooklyn. Patients with serious acne who tried Proactiv, in her experience, were unhappy with the results and sought prescription treatments, she said.

People typically get acne after hormones cause oil to build up in the hair follicles, trapping bacteria and triggering superficial pimples as well as deep, painful lumps. The most severe forms of acne can be disfiguring and emotionally devastating and are often treated with prescription drugs. But until recently, adults with less serious facial blemishes did not necessarily view themselves as having acne, which they considered a teenage problem.

The founders of Proactiv, Dr. Katie P. Rodan and Dr. Kathy A. Fields, dermatologists in the Bay Area of California, developed the brand for this adult market, especially for women who get flare-ups every month before their periods. And in the process they rebranded the word “acne,” making it acceptable to grown-ups.

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Jessica Simpson is one of the stars who promotes the system.

“Women did not identify with acne; they were using euphemisms like ‘stress bumps’ or ‘monthly breakouts’ to describe their problems because they thought acne was an ugly four-letter word or they thought acne was just for teenagers,” Dr. Rodan said. She and Dr. Fields receive royalties on Proactiv sales. “What the infomercial did was give us half an hour to explain that those breakouts you are suffering on a monthly basis are really acne and it is not a curable problem, but it is treatable and manageable,” Dr. Rodan said.

There are no definitive statistics on the prevalence of acne. Nearly 17 million Americans have acne, according to the Web site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, www.niams.gov, a division of the National Institutes of Health. Meanwhile, the American Academy of Dermatology, which received several million dollars last year from pharmaceutical companies, said 40 million to 50 million Americans have acne; a spokeswoman said that figure is based on a paper, published in the academy’s medical journal, that applied estimates of acne incidence to census data.

But pimples are such a lucrative business that the skin industry is starting to promote acne as if it were a menace on par with heart disease.

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Earlier this month, the American Acne and Rosacea Society held a news conference in Manhattan at which one dermatologist described acne as being “at nearly epidemic levels” and another doctor said the group’s purpose was “to defend acne’s status as a legitimate disease”; last year, the society received $285,000 from companies that make acne drugs. Meanwhile, the International Dermal Institute, which trains aestheticians and has just introduced its own acne product line, put out a news release titled “Adult Acne — A Growing Epidemic.”

“We don’t know whether acne is a real epidemic or whether more patients are being driven into dermatologists’ offices thanks to infomercials,” said Dr. Baldwin, who is the president of the American Acne and Rosacea Society; she said she is a paid speaker for nine companies that make acne drugs.

Spotless skin has always had aesthetic value. The zoologist Desmond Morris wrote in his book “Naked Woman” that a smooth, unblemished cheek suggests that a woman is youthful and healthy. Harvard psychologist Nancy Etcoff goes further in her book, “Survival of the Prettiest,” in which she argues that the stigma of pimples has its roots in evolutionary biology. Because acne can be caused by increased androgen levels, potential mates may unconsciously view a woman with blotchy skin as less fertile than someone with clear skin, she wrote.

The basic Proactiv kit includes an antibacterial cleanser with 2.5 percent benzoyl peroxide, a toner with witch hazel to reduce oil, and a treatment lotion with 2.5 percent benzoyl peroxide.

“When you work on prevention, you don’t have to worry anymore that you will wake up and your day will be ruined because you look in the mirror and you have a 50-pound honker on your nose,” Dr. Rodan said.

The doctors took their product formulas to Guthy-Renker, which had already found success marketing self-help guru Tony Robbins. The company developed half-hour Proactiv infomercials using ordinary people to recount their transformations from reticent loners with spotty skin into pimple-free social butterflies. The brand keeps customers coming back with an automatic replenishment system that sends products to people, and charges their credit cards every 60 days.

“Proactiv is automatically replenished, it comes to your own door and it works,” said Karen Grant, the senior beauty analyst at NPD Beauty, a market research firm. “What more could you want?”

Indeed, some people with moderate acne who follow the regimen said that it has worked.

“There used to be some new pimple flaring up on my face every day,” said Tammy Lewis, 28, a nurse in Queens, who has been using Proactiv daily for four years. “Now I only get a few minor red spots and it is manageable.”

But Proactiv may not be for everyone.

“One piddling little zit is not going to hurt you, it is not contagious and you might not need to do anything to treat it,” said Dr. Jodi E. Ganz, a dermatologist in Atlanta. “At the same time, you do worry about people with severe acne who might waste a year and hundreds of dollars trying something that is not going to work for them.”

“I don’t think people should be obsessed with one pimple,” Dr. Ganz said. “But now that everything from lasers to plastic surgery is so available, we as a society are becoming less tolerant. Any little imperfection, whether it is a blemish or an age spot, has turned into a big deal.”